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BJA Advance Access published online on August 18, 2008
British Journal of Anaesthesia, doi:10.1093/bja/aen241
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2008. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Prophylactic mirtazapine reduces intrathecal morphine-induced pruritus{dagger}

M. J. Sheen1,*, S.-T. Ho1, C.-H. Lee2, Y.-C. Tsung1, F.-L. Chang1 and S.-T. Huang1

1 Department of Anaesthesiology
2 Department of Orthopaedic Surgery, Tri-Service General Hospital, National Defense Medical Center, 325, Cheng-gong Road Section 2, Neihu, Taipei 11490, Taiwan

* Corresponding author. E-mail: mkjsheen{at}ndmctsgh.edu.tw

Background: Activation of the serotonergic system is an important factor in the pathogenesis of intrathecal morphine-induced pruritus. Mirtazapine is a new antidepressant that selectively blocks 5-HT2 and 5-HT3 receptors. We therefore tested the hypothesis that preoperative mirtazapine would reduce the incidence of intrathecal morphine-induced pruritus.

Methods: One hundred and ten ASA I patients undergoing lower limb surgery under spinal anaesthesia were randomly allocated into two equal groups and received either mirtazapine 30 mg or an orally disintegrating placebo tablet 1 h before operation in a prospective, double-blinded trial. All patients received an intrathecal injection of 15 mg of 0.5% isobaric bupivacaine and 0.2 mg preservative-free morphine. The occurrence and the severity of pruritus were assessed at 3, 6, 9, 12, and 24 h after intrathecal morphine.

Results: Pruritus was significantly more frequent in the placebo group compared with the mirtazapine group (75% vs 52%, respectively; P=0.0245). The time to onset of pruritus in the two groups was also significantly different. The patients who experienced pruritus in the placebo group had a faster onset time than that in the mirtazapine group [mean (SD): 3.2 (0.8) vs 7.2 (4.1) h, P<0.0001].

Conclusions: Mirtazapine premedication prevents pruritus induced by intrathecal morphine in patients undergoing lower limb surgery with spinal anaesthesia.

Keywords: anaesthetic techniques, subarachnoid; analgesics opioid, morphine; complications, pruritus; pharmacology, mirtazapine

{dagger} Presented in part at the Annual Meeting of the American Society of Anesthesiologists, San Francisco, CA, USA, October 15, 2007.


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